ACCESSORY SPLEEN PRESENTING AS A LIVER MASS

Abstract

A 63 years old hispanic female admitted with urosepsis and found out to have elevated liver enzymes with a cholestatic pattern and mildly thrombocytopenic. The possibilities of infectious and autoimmune hepatitis were ruled out by the negative serologies. The ultrasound was also negative for any obstructive cholangiopathy. The abnormal liver tests were then presumed to be secondary to the sepsis. An incidental finding of a mass about 10 cm in size of the left lobe of the liver was seen on the computed tomography of the abdomen which was done with and without intravenous contrast for the workup of the nephrolithiasis. The CT-guided biopsy of the mass was done to rule out the possibility of hepatic adenoma, hepatocellular carcinoma, and focal nodular hyperplasia. The tissue pathology was reported as fragment of hemorrhagic tissue suspicious for splenic tissue, and no hepatic tissue was seen. The tumor markers including Alfa-fetoprotein, CA 19–9 and CEA were negative and as was her colonoscopy. The issue was re-addressed with the radiologist, who suggested to go ahead with the technetium 99m labeled heat treated RBCs nuclear study to rule out the splenic tissue because he was convinced that he had biopsied the “liver mass.” The nuclear study revealed intense activity in the spleen which extended into the suspected liver mass, and the bone marrow. The final diagnosis was that the liver mass was in fact the accessory splenic tissue. Accessory spleen has been found in about 10–30% of the normal population. It has been clinically associated with hemolytic anemia, idiopathic thrombocytopenic purpura and hereditary spherocytosis. On review of the literature there were none found larger than 2.5 c.m. The size of the accessory spleen reported in our case is 10 cm, which is the largest ever documented.